Supplement Plans

Medicare Supplement Plans

A Medicare supplement insurance plan is sold by private companies. It can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Some policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S.A Medigap policy is different from a Medicare Advantage Plan. Advantage plans are ways to get Medicare benefits, while a Medigap policy supplements your Original Medicare benefits.

If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for your covered health care costs.

Then your Medigap policy pays its share.

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What are Medigap Plans?

A Medigap plan and a Medicare supplement are one in the same. They are two names for the same thing. So when you see the words “Medicare supplement, it is interchangeable for the word “Medigap”. These plans are also called “Medicare Supplemental Insurance”

Medicare Supplement Plans Comparison Chart

There are 10 standardized Medicare supplement plans available in most states. In Massachusetts, Minnesota, and Wisconsin, Medigap policies are standardized in a different way. The plan names are letters of the alphabet, plans A, B, C, D, F, G, K, L, M, and N.

The chart below will compare Medicare supplement plans by showing basic information about the different benefits that Medigap policies cover. If a check mark appears, the plan covers the described benefit 100%. If a percentage appears, the plan covers that percentage of the benefit.

Comparison Chart Benefit Explanation

  • Medicare Part A Coinsurance and Hospital Costs: For most hospital stays, Medicare pays all of the first 60 days except for a deductible, all but $329 per day of the 61st through the 90th day, all but $658 per day of the 91st through the 151st day (one time), and nothing after the 151st day. All plans pay for these copays as well as 100% of an additional 365 days.
  • Medicare Part B Coinsurance or Copayment: Generally, Medicare pays 80% of these costs. All plans pay for some or all of the remaining 20% as indicated on the comparison chart.
  • Blood, First Three Pints: All plans pay for some or all of the fist three pints as indicated on the Comparison Chart. Medicare pays 100% of any additional blood needed.
  • Part A Hospice Care Coinsurance or Copayments: All plans pay for some or all of the Medicare copayment or coinsurance as indicated on the Comparison Chart. Medicare pays for all remaining approved hospice care costs.
  • Skilled Nursing Facility Care Coinsurance: This is a facility that handles the required daily involvement of skilled nursing or rehabilitation staff. Examples of skilled nursing facility care include intravenous injections and physical therapy. Medicare pays all of the first 20 days, all but $164.50 per day of the 21st through the 100th day of approved costs. Medicare pays nothing after the 100th day. The plans pay all, some or none of the first 100 days deductibles or copays as indicated on the Comparison Chart.
  • Part A Deductible: This is a hospital stay deductible. The amount in 2017 is $1316 per stay. The plans pay for all, some, or none of the deductible as shown on the Comparison Chart.
  • Part B Deductible: This is a yearly deductible you must pay before receiving any covered Part B benefits like doctor visits and most other outpatient services. For 2017 this deductible is $183. Only Plans C and F pay for this deductible as indicated on the Comparison Chart.
  • Part B Excess Charges: This is an amount that a health care provider is allowed to charge above the Medicare approved amount. Only Plans F and G pay this benefit as shown on the Comparison Chart.
  • Foreign Travel Emergency: This is medically necessary emergency care not covered by Medicare. The benefit is generally 80% to a lifetime maximum of $50,000 with a $250 deductible. Some plans pay this benefit as indicated on the Comparison Chart.

Medicare Supplement Plans Benefits

Even though Medigap plans are run by private companies such as Blue Cross, United Healthcare, or Humana, every Medigap policy must be standardized and must follow Federal and state laws.There are multiple “F” plans offered by multiple companies, but they’re all exactly the same plan by Medicare rule. This makes it easy to compare “F” plans between two companies, since they are the exact same coverage but not necessarily the same price. To clarify further still, that means that each private company that offers a certain plan has to offer the exact same benefits as their competition. The same can be said for the “N” plans, the “C” plans, and so on.

Each insurance company decides which Medigap policies it wants to sell, although state laws might affect which ones they offer. Insurance companies that sell Medigap policies:

  • Don’t have to offer every Medigap plan
  • Must offer Medigap Plan A if they offer any Medigap policy
  • Must also offer Plan C or Plan F if they offer any plan

With a Medicare supplement policy (Medigap) you can go to any doctor, or other health care provider, anywhere in the United States, as long as that doctor or provider accepts Medicare.

A good starting point to compare Medicare supplement plans is Medicare’s online plan finder tool.

Here are some other important facts you must know:

  1. You must have Medicare Part A and Part B to enroll in a Medigap Policy.
  2. If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.
  3. You pay the private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.
  4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
  5. You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one.
  6. Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium.
  7. Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Medicare Part D)
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Medicare Supplement Cost

Insurance companies set prices for Medigap policies in 1 of 3 ways:

  1. Attained-Age Rating — This is the most common way policies are priced in California. Attained age-rated policies increase in price as you age, because as you get older, you typically require more health care. Certain companies increase the premium each year; others increase the premium every 4 years based on age.
  2. Issue-Age Rating —Premiums in these policies are based mostly on your age when you buy the policy. Unlike attained age-rated policies, issue age-rated policies do not increase in cost simply because you get older. However, their premiums can increase for other reasons, such as inflation.
  3. Community Rating — This is the least common way policies are priced in California. No age-rated or community-rated policies cost the same to all members, regardless of age. Within this structure, younger members may pay more than they would for other policies, and older members may pay less.

Regardless of which type of pricing your Medigap insurer employs, the price will most likely increase each year because of inflation and rising health care costs.

As a general rule of thumb, premiums that are based on both age and increased medical costs typically increase faster and at a steeper rate than other premiums.

Below, as an example, you will see Plan F and Plan N premiums for 5 popular insurance companies that offer a Medicare supplement plan. The first one shows the monthly premium at age 65 and the second shows those rates for someone age 70.

These are sample rates for the San Francisco area:

In addition, you must still pay your Medicare Part B monthly premium (134 in 2017)).

Medicare Supplement Plans Enrollment

In most states, there is a “guaranteed acceptance” or “open enrollment” period during these specific times:

  • The 6 month period beginning with the first day of the month in which you are both age 65 or older and enrolled in Medicare Part B
  • Within the last 6 months you lost an employee sponsored health plan or other prior health insurance was terminated, and you are age 65 or older

This means the insurance company can’t do any of these because of your health problems:

  • Refuse to sell you any Medigap policy it offers
  • Charge you more for a Medigap policy than they charge someone with no health problems
  • Make you wait for coverage to start (except as explained below)

If you are older than age 65, and the open enrollment period does not apply, you may still apply for a Medicare supplement. You will need to answer some medical questions in order to be accepted in a plan.

Pre-Existing Conditions

While the insurance company can’t make you wait for your coverage to start if you qualify for guaranteed acceptance, it may be able to make you wait for coverage related to a pre-existing condition.

A pre-existing condition is a health problem you have before the date a new insurance policy starts.

In some cases, the Medigap insurance company can refuse to cover your out-of-pocket costs for these pre-existing health problems for up to 6 months. This is called a “pre-existing condition waiting period.” After 6 months, the Medigap policy will cover the pre-existing condition.

Coverage for a pre-existing condition can only be excluded in a Medigap policy if the condition was treated or diagnosed within 6 months before the date the ” existing condition waiting period, the Medigap policy will cover the condition that was excluded.

Keep in mind, though, for Medicare-covered services, Original Medicare will still cover the condition, even if the Medigap policy won’t cover your out-of-pocket costs, but you’re responsible for the Medicare coinsurance or copayment.

Prescription Drug Plan (Medicare Part D)

As we mentioned earlier, Medicare Part A and Part B, along with a Medicare supplement will cover most or all of your Medicare approved medical costs except prescription drugs.So, when you choose to purchase a Medicare supplement policy, you would most likely enroll in a Prescription Drug Plan (Medicare Part D) as well.

Since January 1, 2006, prescription drug plans (Medicare Part D) have been available to everyone with Medicare. If you decide not to join a Medicare Prescription Drug Plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you’ll likely pay a late enrollment penalty.

To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.

In general, Medicare Part D covers the cost of prescription drugs. The amount of coverage will depend on the drugs you take, and whether or not you are in the Coverage Gap (donut hole), or in Catastrophic Coverage. To get complete information on prescription drug plans, and to determine which plan is right for you, visit our Prescription Drug Plans page or Contact us.

Contact us to find out what your cost would be and help with choosing the right plan.

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